prescribing mass funded orthoses - queensland … · • supra-malleolar combined with lsafo, safo,...
TRANSCRIPT
Prescribing MASS Funded Orthoses
Presenters• Rod Goodrick (Orthotist / Prosthetist)
(Goodwill Orthopaedics)
• Bianca Nielsen (Orthotist / Prosthetist)
(Orthotic Solutions Qld)
Presentation Overview
• AOPA• What is an Orthosis• The Function of Orthoses• The ‘Language’ of Orthoses
• Classifications, Styles & Descriptors
• MASS Commonly prescribed Orthoses
AOPA• AOPA (Australian Orthotic Prosthetic Association)
– Peak body representing O & P’s within Australia.
• Orthotist / Prosthetist (Allied Health Professional)– Qualifications (Bachelor P&O, Bachelor of HS / Master of Clinical P&O)
– Clinical role (patient physical & gait assessment, prescription & design)
• Skill-set: Anatomy, Physiology, Biomechanics, Pathology
– Technical role (complete manufacture of P&O devices)
• Why use AOPA Certified Prosthetist/Orthotist?– Meets competency standards, PLUS– Compulsory Continued Professional Development
(CDP)
AOPA• AOPA’s Representation to...
– Federal/state Gov., industry stakeholders, employers & public– Providing information/guidance regarding
• Qualifications, • Professional standards, and • Funding matters.
• AOPA and MASS working together to…– Facilitate a ‘common understanding’ of Orthoses between
Providers, Prescribers, Applicants and MASS. – Ensure a high standard of service delivery and positive patient
outcomes– Ensure a user-friendly scheme for all involved
What is an Orthosis?
• Orthosis (pl.Orthoses): An externally applied device used to modify the structural or functional characteristics of the neuro-muscular-skeletal systems. Orthoses may be Prefabricated, Customised or Custom Made.
• Orthotist (pron: Ortho-tist): An allied health professional who is clinically responsible for the assessment, design, manufacture and provision of all types of Orthoses.
The Function of an Orthosis
1. Immobilisation
2. Restriction of Motion (ROM)
3. Enhance Biomechanics
4. Force Re-distribution
The ‘language’ of OrthosesThe Importance of a Common Language: Why bother?
• Uniformed Description of Devices ‘across the board’
• Eliminates the confusion associated with ‘regional’dialect
• Facilitates a common understanding between Orthotists, Therapists, Referrers, Patients & MASS
The Confusion…
Articulated AFO, Jointed AFO, hinged AFO, Toe Pick-up Brace, Foot Drop Splint, Dorsi flexion Assist AFO, Free ROM AFO…
The ‘language’ of Orthoses
To Overcome This Confusion…
When prescribing or making reference to an Orthosis…
Use1. Classification
2. Style (if applicable)
3. Descriptors (if applicable)
1. The Classification of Orthoses• A globally recognised Nomenclature (Classification system)
• Orthoses are described by the body part or anatomical joint(s) that they influenced/encompass.
• Orthoses are described by Function: Solid (SAFO) or Articulated (AAFO) or Dynamic (DAFO)
• Acronyms (abbreviations) are used to simplify the nomenclature.
Classification: Ankle Foot Orthosis
Articulated
Acronym: AAFO
Lower Limb Orthoses
Lower Limb
Orthoses
Lower Limb
Orthoses
KO
HKAFO
KAFO
FO
AFO
Spinal Orthoses
Spinal Orthoses
Spinal Orthoses
CO
TLSO
CTLSO
LSO
2. The Style of Orthoses• Typical names or Labels• Generally describes a group of design elements that deem
an Orthosis a certain ‘style’• Typically determined in consultation with Orthotist
Classification: AFOStyle: RWRAP Classification: AFO
Style: LEAF SPRINGClassification: KAFO
Style: STANCE CONTROL
Classification: CTOStyle: HALO
Lower Limb Orthoses- AFOs
Ankle Foot
Orthoses (AFO)
SOLID(SAFO)
ARTICULATED(AAFO)
DYNAMIC(DAFO)
3. The Design Descriptors• Additional terminology to assist when describing
• Refers to additions, components or features
• Typically determined in consultation with Orthotist
Examples:
Sole, Tongue, DR bands, T-strap…
The ‘Language’ of Orthoses
• Material Selection – Thermoplastic– Metal– Laminated (Composite)– Other (hybrid)
• Typically determined in conjunction with Orthotist.
The ‘language’ of OrthosesHow to describe an Orthosis
• Adverb e.g. Unilateral (UL) L/R or Bilateral (BL)
• Classification (acronym) e.g. AFO, TLSO
• Style (if applicable) e.g. Solid / Articulated / DynamicR-Wrap, Leaf Spring
• Design Descriptors (if applicable) e.g. Sole, Tongue, Lined
The ‘Language’ of Orthoses
Unilateral (R) Articulated Ankle Foot Orthosis
(AAFO) Into shoe with 90° Plantar Flexion Stop & heel block.
Bilateral Ankle Foot Orthosis (supra-malleolar Style)
Into shoe
MASS
commonly prescribed
Lower Limb Orthosis “Styles”
Supra-Malleolar AFO
Adverb: Bilateral (BL)Classification: AFOStyle: Supra MalleolarDesign Descriptors: Into shoe, Diagonal Strap
General Description: • Medial / Lateral Trimlines extending superiorly to Mals. • Mid foot dorsal wrap• Thin thermoplastic (1.8-3mm)• Trimlines to allow dorsiflexion / plantarflexion• Into shoe only
Indication:• Mild to moderate Medical / Lateral (subtalar) instability
R-WRAP AFOAdverb: Unilateral (R)Classification: SAFOStyle: R-WRAP Design Descriptors: Into shoe, Top Diagonal Strap
General Description:• Thin thermoplastic (1.8-2mm)• Total Contact Design (circumferential) • Lightweight• Transverse plain flexibility
Function:• Immobilise foot/ankle in high tone or unstable pts
Indication:• Hypertonicity (spasticity) & involuntary movements• Highly unstable foot/ankle complex• Often used for difficult clients when other styles are not tolerated.
BIVALVED AFOAdverb: Unilateral Classification: SAFOStyle: BivalvedDesign Descriptors: Tongue, Sole, Lining…
General Description:• Thermoplastic • Anterior Tongue (external/internal)• Anterior force distribution• Bilvalved External Tongue (CROW Style)
Indication:• Accommodate fixed deformities• Indications same as R-WRAP• CROW (Charcot / Diabetic / Ulcer MX)
GRAFO (Ground Reaction AFO)
Adverb: Unilateral (R)Classification: SAFOStyle: GRAFODesign Descriptors:
Description:• Thermoplastic / Laminated CF Compsite• Proximal Anterior Shell
Function:• Manipulation of the GR force to influence sagittal plane
kinematics (via forefoot and prox. shell relationship)
Indication: Knee flexion instability (crouch gait), Stance phase control (knee flex weakness, hyper ext.)
Dynamic AFO
Adverb: Unilateral (L)Classification: DAFOStyle: GRAFODesign Descriptors: Laminated Carbon Fibre
Description:• Plastic - CF (hybrid) / Laminated
Function:• Dynamic property offering yielding and energy store/release during gait
Indication: • Active Pts requiring biomechanical enhancement.
Combo AFOAdverb: Unilateral (R)Classification: SAFOStyle: Combo AFODesign Descriptors:
Description:• Supra-Malleolar combined with LSAFO, SAFO, AAFO, DAFO
Function:• Inner Supra-Mal provides circumferential wrap (coronal plane control)
whilst AFO component manipulates sagittal plane kinematics
Indication: • Where the degree of sagittal and coronal plane control requirements
differ.
MASS Funded Lower Limb OrthosesPrefix Classification Style (e.g.) Descriptors (e.g.)
• Unilateral (L/R)• Bilateral
FO(not foot orthotics)
• SUB-MALLEOLAR• UCBL
AFO
Solid (SAFO)Articulated (AAFO)Dynamic (DAFO)
• SUPRA-MALLEOLAR• R-WRAP• CROW • GRAFO• BK CALIPER
plus more….
• Sole (Standing, Walking, Rocker)• Mid Foot Wrap• Tongue (Internal/External)• Dorsi-Resist Bands• Padding / Lined
plus more….
KOLocked /Jointed
KAFOLocked /Jointed
• AK CALIPER• STANCE CONTROL
HKAFOLocked /Jointed
MASS Funded Spinal OrthosesPrefix Classification Style (e.g.) Descriptors (e.g.)
LSO Chairback LSOCorset LSO
plus more….
TLSO Boston TLSOTaylor TLSOCorset TLSO
plus more….
CTLSO Milwaukee CTLSOMinerva CTLSO
plus more….
CO Miami J CollarHeadmaster Collar
plus more….
Final Points• AOPA is committed to providing education/ information
regarding:• Qualifications• Professional Standards• Funding Matters
• AOPA and MASS working together to facilitate a ‘common understanding’ of the funding of Orthoses via MASS
• Common language of Orthoses:Prefix, Classification, Style, Descriptors..
• Watch this space!